Book Review

Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes

N Engl J Med 2007; 356:1792April 26, 2007

Article

Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes
By Mohammadreza Hojat. 295 pp. New York, Springer, 2007. $59.95. ISBN: 978-0-387-33607-7

To the busy physician, increasingly squeezed by the demands of managed care and distanced from patients by tests and technologies, empathy might seem like a luxury or an irrelevance. The concept itself can seem vague and impractical. Empathy is sometimes viewed as a kind of emotional incontinence that impairs clinical objectivity, or as the sole preserve of the nursing staff. The author of this book disagrees, arguing that empathy is not only a critical ingredient in patient care but also something that can be defined, measured, and investigated. Mohammadreza Hojat, a prominent researcher in medical education, makes the case that empathy is not a mere abstraction but a psychological attribute that has concrete clinical benefits. He argues that empathic engagement with patients is an essential response to a deep human need for social connection — a need that is often deepened among the ill and can be harnessed for therapeutic ends.

The opening chapters review the concept of empathy, clarifying alternative views and proposing a working definition that emphasizes its cognitive components (e.g., taking and understanding the other's perspective) and that distinguishes these components from emotional sharing (i.e., sympathy). Empathy is placed in the contexts of biological, psychological, and developmental research, and its importance in the clinical encounter is forcefully laid out. Later chapters, which have a more applied focus, present a psychometric measure of empathy that is tailored to research on patient care. Here Hojat shows how empathy enhances clinician–patient encounters and thus can lead to positive clinical outcomes. For example, empathic connection in clinical settings can contribute to earlier and more accurate diagnosis, better treatment adherence, and greater patient satisfaction. Apart from its intrinsic clinical rewards, the use of empathy may also reduce malpractice litigation.

The concluding chapters examine how individual differences in empathy are related to gender, specialty choice, and clinical competence and what methods can be used to foster the use of empathy among professionals. These methods often run counter to cynicism about medical training and the increasingly technical orientation of medical practice. Acknowledging the limitations of existing work on the subject of empathy, Hojat proposes several directions for future research and policy. If the capacity for empathy is a better predictor of clinical performance than academic results, for example, should it be factored into the admissions process for medical schools and residencies?

Among the strengths of this book are its thorough and up-to-date reviews of varied specialist literatures and its author's consistently humanist voice. Although his tone is more empirical than poetic, the author never loses sight of the complexities of empathy, nor does he reduce the practice of empathy to an easily learned toolkit of interpersonal skills. At times, Hojat appears a little too sure that empathy is the single active therapeutic ingredient in the clinician–patient relationship, and he occasionally presents it as a panacea. The distinction between the cognitive and emotional aspects of empathy is a little stark and overdrawn, and it can be argued that the author's measure of empathy assesses clinicians' attitudes toward empathy more than it does their inclination to be empathic. The biggest limitation of the book is the paucity of research that establishes a causal role for empathy in enhancing clinical outcomes; Hojat energetically advocates for more research.

Nick Haslam, Ph.D.
University of Melbourne, Melbourne, VIC 3010, Australia